The review assessed a range of local estrogen delivery systems, including creams, tablets, capsules, pessaries, rings, gels, and ovules, as well as different estrogen compounds such as estradiol, estriol, promestriene, conjugated equine estrogens, and estrone. Nappi et al. compared the available evidence to determine how these therapies perform in clinical practice and whether specific formulations offer advantages for particular patient populations.

Based on the studies reviewed, Nappi et al. concluded that local estrogen therapy remains the gold standard treatment for moderate to severe GSM symptoms, including vaginal dryness, dyspareunia, and other vulvovaginal and urinary complaints. The authors found that most local estrogen products produce similar improvements in symptoms and vaginal health, with no single formulation consistently demonstrating superior efficacy.

A key finding highlighted is that low-dose and ultra-low-dose local estrogen therapies provide meaningful symptom relief while maintaining minimal systemic absorption. The authors note that circulating estrogen levels generally remain within the postmenopausal range, supporting the favorable safety profile of these treatments for most women.

Nappi et al. ultimately emphasize that treatment selection should be individualized. Because the available products demonstrate broadly comparable efficacy, factors such as symptom presentation, anatomical involvement, ease of administration, patient preference, adherence, and overall treatment goals should guide therapeutic decisions. The authors advocate for a tailored approach to GSM management, recognizing that different formulations may better meet the needs of different patients despite achieving similar clinical outcomes.

You can view the full study, here: https://www.tandfonline.com/doi/abs/10.1080/136971...